Low serum potassium levels are associated with the risk of atrial fibrillation

Acta Cardiol. 2021 Oct;76(8):887-890. doi: 10.1080/00015385.2020.1799573. Epub 2020 Jul 29.


Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. AF is associated with approximately a threefold to fivefold increased risk for stroke. Hypokalaemia is associated with ventricular arrhythmias and cardiac arrest. Little is known about the association of serum potassium with atrial fibrillation.

Aims: The aims of this study are to assess the association of low serum potassium (hypokalaemia) and the risk of AF.

Methods: Retrospective data were collected for all patients' records, who were hospitalised at department of Internal Medicine of Ziv Medical Centre, Safed, Israel, from January 2013 to December 2017 with AF. Clinical data were obtained from patient's hospital records. We excluded those who were pregnant, diagnosed with malignancy and those with thyrotoxicosis. Control group consisted of patients who were hospitalised in the same period with normal sinus rhythm (NSR). We compared between the two groups in term of age, gender, comorbidities and serum levels of potassium and magnesium.

Results: We enrolled 281 subjects with AF who responded to our study purposes. The control group consistend of 260 with NSR. Hypokalaemia of less than 3.5 mmol/l was found in 16% in the study group vs. 8.4% in control group, p = 0.001. Multivariate regression analysis showed that OR 2.08, 95% CI (1.378-3.138), p = 0.01, and hypokalaemia < 3.5 mmol/l OR1.827, 95%CI (1.50-3.179), p = 0.02 were found to be associated with atrial fibrillation.

Conclusion: We found that low serum potassium levels of less than 3.5 mmol/l are associted with increased risk of AF.

Keywords: Atrial fibrillation; carduiovascular; hypertension; hypokalaemia.

MeSH terms

  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / etiology
  • Humans
  • Hypokalemia* / diagnosis
  • Hypokalemia* / epidemiology
  • Hypokalemia* / etiology
  • Potassium
  • Retrospective Studies
  • Stroke*


  • Potassium